Mercy Hospital Fairfield plans to start construction next spring on the first open-heart surgery unit in Butler County.

The expansion, estimated to cost up to $23 million and be complete in late 2001, will add operating rooms, a cardiac catheterization lab and 42 beds including cardiac intensive care and lower intensity step-down beds.

Mercy officials say full-scale cardiac care services have been long overdue for the growing population of Butler County, which now exceeds 323,000. Butler County has five hospitals, but none offers open-heart surgery.

The open-heart expansion reflects the latest development in a continuing flow of health services from the central city to the suburbs.

However, the project will make Mercy Fairfield the seventh hospital offering adult open-heart surgery in Greater Cincinnati, a metropolitan area that many say already has too many open-heart services.

This may be a very appropriate growth initiative for Mercy. However, adding another physical plant to the community when we are already in oversupply ultimately will increase health care costs for the community, said Stu Scheller, a health care consultant with the Scheller Bradford Group.

Hospitals complain they lose money on payments from public and private health plans, yet continue to spend more on new projects, Mr. Scheller said.

It will be employers and consumers who end up paying the higher bill, Mr. Scheller said. Why is it that hospital systems never get the blame and the managed care plans always get the black eye for raising premiums?

Dave Ferrell, president of the Mercy hospitals in Fairfield and Hamilton, said he believes the new open-heart unit will better serve residents without driving up costs.

If there are too many open-heart units in town, that isn't Mercy's fault. It's more because the services concentrated on Cincinnati's Pill Hill have been slow to respond to the times, Mr. Ferrell said.

This is an era of competition. We have seen the preference of suburban patients to seek care in their own areas, Mr. Ferrell said. My question would be why hasn't there been more dispersion of programs concentrated on Pill Hill?

However, surveys conducted by the Health Alliance of Greater Cincinnati  which includes Christ, Jewish and University hospitals  indicate that suburban residents find it acceptable to travel moderate distances for specialty medical services.

How long does it take to drive from Fairfield to downtown? Maybe 30 minutes? If the question is, "Do we need another open-heart program in this community?' The answer is, "Of course not,' said Health Alliance chief executive Jack Cook.

The data clearly show there is not increased demand, so (Mercy's new unit) is just dividing it up, Mr. Cook said.

The Mercy Fairfield venture will be co-owned by Mercy Health Partners, Deaconess Associations Inc. (which runs an open-heart unit on Pill Hill at Deaconess Hospital), and a doctor group called Greater Cincinnati Cardiovascular Consultants.

The new unit fully expects to draw patients away from Pill Hill, including Deaconess. In fact, Mercy Fairfield would be the third hospital, after Jewish Hospital in Kenwood and Bethesda North in Montgomery, to expand or move open-heart services to the northern suburbs.

Mercy estimates that 700 patients a year, including at least 200 patients of Mercy Fairfield, leave Butler County for open-heart surgery. About 575 go to Cincinnati hospitals and 125 go to Dayton hospitals.

The hospital predicts it will do 250 to 260 open-heart procedures during its first year of service, and 450 to 500 procedures a year within five years.

State regulations say open-heart units should provide at least 250 procedures a year by their second full year of service in conjunction with meeting quality goals.

That means a hospital can do fewer than 250 procedures, if it maintains high quality. However, failure to meet volume goals for two straight years can trigger inspections and audits from the Ohio Department of Health, said spokesman Randy Hertzer.

For many years, hospitals had to win approval from the Ohio Department of Health to launch new services. And for many years the department refused to approve new open-heart services in Greater Cincinnati because officials believed there were too many  a situation that hasn't changed.

But state approval hasn't been an issue since deregulation of the hospital industry began in 1995.

We don't get into that discussion anymore, said Randy Hertzer, health department spokesman. Instead, we make sure any new ones coming in meet certain quality standards. Whether they enter the market or survive is up to them.